Anne McIntosh: It would be helpful to know what issues the Advocate-General considered. Will the Minister confirm that foreign policy and extradition matters will remain the preserve of the UK Government, and that they will reject moves by the Justice 2 Committee of the Scottish Parliament to prevent a Scottish businessman from being extradited to the USA to face charges under the extradition treaty, despite the fact that the person in question might be the son of a Labour MSP?

Vera Baird: I understand why the hon. Gentleman has raised the issue, but I can assure him that everyone is bearing that point in mind. The proposal is likely be a combination solution: "bigger is better" firms will probably be involved, but there is definitely a place for niche firms. May I mention the issue of BME—black and minority ethnic—small firms, as it has caused a great deal of concern? In his report in February, Lord Carter said that it will
	"be particularly important in respect of black and minority ethnic firms, to ensure that suppliers continue to reflect the diversity of the communities they serve."
	That is a very important point. My right hon. and learned Friend the Minister of State has since met the Black Solicitors Network, and we will very much bear in mind the need for people of the same profile as defendants to be available to look after their interests.

MISUSE OF DRUGS (RECLASSIFICATION OF METHYLAMPHETAMINE)

Bob Spink: I beg to move,
	That leave be given to bring in a Bill to reclassify methylamphetamine as a category A drug.
	This is yet another sad tale of a failing Home Office. This time, it is failing to protect people from the misuse of crystal meth, which is seriously bad news for individuals who use it and for society at large.
	The widely respected New York police chief, Anthony Izzo, told the Select Committee on Science and Technology:
	"Crystal meth makes crack cocaine look like a Hershey Bar."
	He bases his view on hard evidence and experience. UK Sky TV news coverage showed the drug's impact on individuals and called for Government action before use of this nasty drug becomes endemic. But the Home Office says that it is not yet very prevalent in the UK and that, in effect, they will reclassify when a greater number of people have been damaged and communities are suffering more serious consequences. That is hardly the precautionary approach that the public deserve. It is hardly the action of a Government who care about their young people or want to minimise the impact of drug abuse on society.
	Methylamphetamine is one of a group of psychostimulant drugs called amphetamines that act on the brain and nervous system. It is produced in tablet, powder or crystalline form. It is taken orally, snorted or injected, but unlike amphetamine, it can be smoked.
	The term "crystal meth" is often used for the purer crystalline form. The drug's street names include "yaba" for tablet form, "ice", "glass", "Tina", "Christine" and "Nazi crank". It was first developed in 1919 and used by troops to keep awake. It was rumoured that Hitler injected it twice a day, hence the name "Nazi crank". The chances of getting hooked are incredible compared with other illicit drugs. Psychological and physical dependence happens quickly. It affects the brain reward pathways. Users must take more to achieve the same effects, as tolerance quickly builds up. Using the drug by intravenous injection or smoking is especially likely to cause addiction. Smoking the purer, crystalline form produces an intense rush, similar to that of crack cocaine, but much longer lasting—not only minutes but four to 12 hours. That is highly reinforcing and becomes highly addictive. The higher potency, especially when smoked, makes the drug a greater threat. It is, all too often, a one-drag-and-you're-hooked drug.
	The drug's effects are appalling. They include agitation, paranoia, confusion and violence, usually against innocent bystanders. It damages more than those who take it. It can bring on feelings of exhilaration and produces increased arousal and activity levels. It causes a rapid rise in heart rate and blood pressure, and the higher the dose, the greater the effects.
	The risks are enormous. Methylamphetamine-induced psychosis has been widely reported in countries where use has become endemic. High dosages lead to strokes and pulmonary, renal and gastrointestinal disorders. Coma and death can and do follow. It is a much more serious drug than the class A ecstasy that killed Leah Betts in Essex a decade ago. Yet the Government appear to have learned nothing from that tragic wake-up call.
	Methylamphetamine is often injected, with sharing of paraphernalia and all the consequences of infection. The drug also increases libido and risky sexual behaviour, thereby increasing blood-borne virus transmission. Home Office research shows that the drug is especially used by the homosexual community. It is disastrous for that group to reduce sexual inhibitions or undertake ever more risky behaviour.
	Methylamphetamine is currently a class B drug under the Misuse of Drugs Act 1971. That historical classification results from the drug's chemical association with amphetamines, which were all classified B. The Advisory Council on the Misuse of Drugs, which reports to and advises the Government on the classification of drugs, is as dysfunctional as the Home Office. It meets just twice a year with a quorum of only seven, but comprises 38 people, some of whom are caring, knowledgeable, professional and sensible. However, too many represent a neo-liberal, politically correct rag-bag, who appear to make decisions without excessive reference to the evidence and the consequences.
	James Randerson, science correspondent for  The Guardian, reported on 24 April that Professor Rawlins, chairman of ACMD
	"blew the gaff on government claims that its drug policy is 'evidence based'."
	The classification for illegal drugs is riddled with anomalies and simply does not work. That is echoed by the Science and Technology Committee's research, which found:
	"Drugs are not classified on the basis of... the harm they cause."
	Indeed, they are not classified according to any consistent set of criteria. On 1 March,  The Times home correspondent, Richard Ford, ran the headline:
	"Lax laws 'could turn Nazi crank into global epidemic'".
	The article stated:
	"A new highly addictive drug used in Britain by clubbers and gay men is becoming a global problem, according to a United Nations report.
	The huge increase in crystal meth is helped by lax restrictions on the chemicals used to manufacture it. People who take it can experience a ten-hour high and increased sexual arousal.
	Professor Hamid Ghodse, president of the United Nations' drug control agency, said:
	'If I want to pick on one major drug problem pandemic today, it is methamphetamine'."
	Yet, last year, the ACMD recommended that it remained a class B drug.
	Professor Nutt, a distinguished psychopharmacologist and chairman of the ACMD's technical committee, told the Science and Technology Committee that upping the classification could have the perverse effect of making the drug more desirable and thus stimulate demand. He argued that downgrading mushrooms might stimulate demand and that upgrading crystal meth would have the same effect. That is perverse and muddled thinking. I sometime wonder whether the ACMD is personally testing the products when making decisions.
	A shift up the scale could well give a drug more kudos, as Professor Nutt suggests. However, that undermines one of the key tenets of the United Kingdom's drug laws, which is that the more dangerous drugs should be placed in higher, not lower, categories because of the greater risks attached to them. The ACMD seems totally unimpressed by the principles of UK law, by international experience, or by the evidence base.
	Methylamphetamine can be produced in small domestic laboratories from non-controlled precursors. I will not go into details about those precursors today, as it would not be helpful. I have asked the Home Secretary to control those precursors, but he has not done so. The ACMD recommended close monitoring of the drug's use, but this is difficult because the extent of the drug's use in Britain is, in the words of the president of the UN narcotics control board,
	"hidden because seizures were included in figures for amphetamines".
	The Home Office confirmed that, stating:
	"The British Crime Survey does not differentiate between methylamphetamine use and amphetamines".
	I respectfully maintain that the Government are failing to control the drug's precursors and not effectively monitoring its usage. That is unsustainable. The Home Secretary said that he would publish a consultation paper on a review of the drug classification system. He has not yet done so, although he promised this on, I think, 19 January this year. So I call on the new Home Secretary to bring forward that review urgently, and to change the drug classification system to a more consistent and rational one. The Government should take a precautionary approach and immediately reclassify methylamphetamine as a class A drug, so that we can save individuals and society from its terrible consequences.

OPPOSITION DAY
	 — 
	[15th Allotted Day]

Andrew Lansley: I visited that hospital with my hon. Friend and can vouch for the fact those problems were emerging at that time, but we do not need to speculate about how the Government were trying to cover things up in the run-up to the election. The present Secretary of State for Work and Pensions was a health Minister before that election, and in March 2005 he said, "Don't worry about it. At this time of year they're always predicting deficits and it always turns out all right." After the election, the red ink was all over the books.

Andrew Lansley: I am very interested that my right hon. Friend should raise that point, as I want to deal with happened in respect of pay and contracts in December. When the pay review bodies reported, the Prime Minister said that he was proud to be paying NHS staff more, but Labour Members will recall that the Secretary of State met those bodies in December. Although the Department of Health had stated in September that it accepted a pay rise of 2.5 per cent. for NHS staff, she wanted the pay increases for nurses and doctors to be reduced to 2 per cent. and 1 per cent., respectively.
	Interestingly, the pay review bodies rejected the Secretary of State's argument. They said:
	"We do not believe that the assimilation costs of recently negotiated pay modernisation should be taken into account in setting the level of the basic uplift for future years. These costs were part of the negotiated agreement and should have been taken into account during the negotiations rather than clawed back at a later date".
	In other words, the pay review bodies were saying, "Don't come to us asking us to cut future pay settlements because you got the figures on your contracts wrong." The cost of the contracts miscalculation is now £600 million.

Andrew Lansley: Yes. If hospitals were genuinely free and given the opportunity to behave in a businesslike way they would be able to make different arrangements for their financing needs. Indeed, some PCTs are doing just that; things are getting so desperate in the NHS that a PCT in my constituency has borrowed £2.5 million from the local authority. However, I must make progress because we have only reached the new year.
	In January, the Secretary of State's operating framework for 2006-07 said that new guidance on PFI would be published, with the effect of cutting the PFI programme by a third. The guidance never appeared and it is reported that it has gone into limbo, and nobody with a PFI project in prospect knows what will happen. The same document stated that in this financial year
	"for the system as a whole we expect to recover any overspend from 2005/6 and we are planning for a surplus."
	It said that individual NHS bodies should plan both to achieve in-year balance and recover 2005-06 deficits.
	On 12 April, the Secretary of State for Health sent me a letter in response to my inquiries. She said that the objective has changed:
	"All organisations are overspending to show improvement during 2006-7, and by the end of the year everyone should have monthly income covering monthly expenditure."
	What kind of financial balance is that? It happens to coincide with the 12th month of the financial year. The Government's policy has completely changed. They did not tell the House about it; it emerged from a letter written to me. The policy is no longer to achieve financial balance in 2006-07—it may not even be to do so in 2007-08. We simply do not know what is the Government's policy to restore NHS finances.

Andrew Lansley: The question of whether the Secretary of State acted wisely or even reasonably in relation to that matter will be tested soon. We will come back to that question in due course.
	I am afraid that we have arrived at the point in April when the latest statistics added insult to injury for NHS staff. The work force census showed that the number of managers had doubled since 1997. In the last year for which the figures were gathered, the number of administrators went up by 11,000—while the number of nurses went up by 6,000. That is in the teeth of all the Government's claims to want to cut the bureaucracy of the NHS. That is not happening at all. On the basis of all that, on 23 April, the Secretary of State called it "the best year ever". I never want to be around when she thinks that things are going wrong.
	The Prime Minister has retained the services of the Secretary of State at the Department of Health, apparently to push forward NHS reforms. If the Prime Minister believes that, he is living in the parallel universe that the Secretary of State inhabits. Conservative Members believe that reform is essential, but that even more so is leadership and competence. The Government's combination of arrogance and incompetence is a recipe for disaster.
	Every aspect of desirable reform is being undermined by the actions of Health Ministers. Patients should have choice, but PCTs, through referral management centres, are controlling and subverting choice. Patients need a voice, but after scrapping community health councils, the Government are going to abandon patients forums and have no idea what to put in their place. GPs need real GP budgets, but the Government's plans do not offer them the incentives to reinvest their savings or give them the power to negotiate contracts with providers. The Government talk about local decision making, but that is being abandoned because the SHAs are top-slicing PCT budgets and controlling the growth money for the NHS for this year.
	Progress towards foundation hospitals is being delayed and their freedoms are still severely limited. National standards need to be set through the National Institute for Health and Clinical Excellence, but the guidelines are not being implemented and the postcode lottery goes on. The independent and voluntary sectors have no clarity on their future involvement in the NHS. The second wave contracts are being scaled back, and the wave 1 contracts cost 11.2 per cent. more than the NHS price. As independent sector treatment centres are guaranteed payments whether or not they do the work, they are bringing the system of independent contracting into disrepute.
	One cannot talk, as the Prime Minister does, about a patient-focused service that is locally delivered when at the same time the NHS is controlled by an overbearing bureaucracy and politically dictated targets. The team at the Department of Health knows neither what NHS reforms are actually needed, nor how to deliver them. No one in the NHS can say what the destination of reform is. Who will be commissioning services in the future? Will PCTs be both commissioning and providing services? Who will set the tariff? How will financial control be enforced? Will the independent sector have a long-term commitment and the opportunity to supply services to the NHS? What happens to failing hospitals? The team does not know, and the Government will not give, or simply do not know, the answer to any of those questions.
	The time has come for a turnaround and a new team at the Department of Health. Ministers should be removed from their interference in the NHS. If we cannot immediately get a new Government, let us at least have a team brought in that is empowered to deliver NHS reform and the long-term stability that the NHS so badly needs. Such reform should reflect the principles of equity, choice, competition and independence for which we have argued.
	Most of all, the NHS needs leadership. Professor Halligan, who was deputy chief medical officer of the Department of Health until last year, said that the NHS has
	"a leadership void, which has caused it to lose its way".
	He describes the service as "rudderless". Tellingly, he adds that it is
	"extraordinary, the gap between highly motivated frontline staff and the systematic dysfunctionality in which they operate".
	At the risk of using an unparliamentary expression, the situation is what the  Health Service Journal describes as a "total cock-up". Only days ago, the outgoing director of human resources at the Department of Health, Andrew Foster, who is one of the most senior NHS officials, said:
	"It's been almost tangible over the last 15 months, the growing sense of dislocation between the NHS and the Department of Health and a growing lack of confidence in the leadership of the Department".
	Even those working most closely with the Secretary of State express their lack of confidence. NHS staff did so in loud and clear terms. We have no confidence in her stewardship of the Department. It is time for a turnaround. It is time for Conservative policies and, frankly, it ought to be time for a Conservative Government who are committed to a NHS that is energised and equipped to deliver. It is time for change, and I commend the motion to the House.

Patricia Hewitt: I beg to move, to leave out from "House" to the end of the Question, and to add instead thereof:
	"recognises the effective leadership given by the Department of Health in managing the NHS; acknowledges that the majority of NHS organisations are living within their budget and providing patients with better services; welcomes the turnaround in the NHS since 1997 as a result of the dedication and commitment of staff, backed by the Government's programme of investment and reform; congratulates the Government for trebling investment in the NHS by 2008 compared with 1997; welcomes the recruitment of more than 300,000 extra staff in the NHS since 1997 including 85,000 more nurses; notes that waiting lists are now at their lowest since records began with over 370,000 fewer patients waiting for an operation than in March 1997; further welcomes the fact that all patients can now expect to wait no longer than six months for their operation and that 98 per cent. of patients are now seen, treated or admitted within four hours in accident and emergency departments; and applauds the NHS for saving more lives than ever before. Including 43,000 more people saved from cancer and 87,000 saved from coronary heart disease."
	I am delighted to start by welcoming to their posts the Minister of State, Department of Health, my hon. Friend the Member for Leigh (Andy Burnham), on his promotion, and the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis). I take the opportunity to thank my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy) for the work that she has done, especially in securing the new private finance initiative for Barts, the Royal London, St. Helens and the new private finance initiative building programme for Birmingham. I congratulate the new Minister for Policing, Security and Community Safety, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne), on his promotion to the Home Office.
	The hon. Member for South Cambridgeshire (Mr. Lansley) spent the past 40 minutes telling us about everything that he thinks he is wrong with the national health service. A year ago, he was telling people that he believed in the patients' passport—taking money out of the NHS to put into private care. He says now that he has changed his mind and that he really believes in the NHS. Four years ago, he voted against more money for the NHS. Now he and his right hon. and hon. Friends keep demanding more money for the NHS. He and his right hon. Friend the Member for Witney (Mr. Cameron) have turned round their positions so often that the public no longer know what the Conservative party believes in.
	Let me tell the hon. Member for South Cambridgeshire what we have done about turnaround in the NHS. In 1996, I have one cutting from one day. It reads:
	"22 patients spend the night on trolleys. A&E unit closes its doors. Patients diverted to Queen Mary's in Roehampton which is earmarked for closure".
	That was under the Conservative Government. In 2006, no patients were waiting on trolleys for hours on end. There was a maximum wait in accident and emergency of just four hours. That is a turnaround. It is a target that the Conservative party said could never be met and should never be set. It is another example of what the Conservative party describes as Government interference. However, it is a target that NHS staff—more of them than ever before—are delivering. There is a new hospital to be built at Queen Mary's in addition to 81 new hospitals since 1997, and there are many more to come.

Patricia Hewitt: No, I will not. I wish that the hon. Member for Reigate (Mr. Blunt) had acknowledged that in the East Surrey PCT, where more than 600 people used to wait more than 13 weeks for their first out-patient appointment, there are no patients now waiting for such an appointment. There used to be more than 500 people—in fact, there were once more 1,000 people—waiting more than six months for an operation, but now no one waits for an operation for more than six months. That is turnaround.

Andrew Lansley: If it is all about agency staff, will the right hon. Lady explain why, over the last two years, the proportion of the NHS pay bill spent on agency staff has declined at the same time when the deficits have ballooned? If it is all about treating patients closer to home, why are intermediate care beds being closed and why are there fewer district nurses and health visitors? Why are these objectives—they are not new to the Secretary of State, as they started with the right hon. Member for Holborn and St. Pancras (Frank Dobson) in 1998—not being fulfilled?

Steve Webb: The hon. Lady raises the important issue of what the NHS does and does not do, which is separate from the issue of waiting. If some people cannot get treatment at all, it is another facet of that problem.
	We should also talk about what needs to be done. I listened in vain for nearly 45 minutes to the hon. Member for South Cambridgeshire for any suggestions, and there is nothing in his motion about what needs to be done. A constructive and effective Opposition says what needs to be done, so I shall point out several measures that need to be taken.
	The first is that if one accepts the Government's logic, the NHS should be given greater time to adjust. If one believes in a market directed by incentives—including incentives to be more efficient—it needs time to adjust. Incentives do not work over night. If the NHS is to be restructured, new units built and old ones closed, the effect will take time to be felt. The logic of the Government's position is that we should not have wholesale reform all at once to be implemented quickly. Instead, change should be phased, staged and managed, but that is not what is happening. One cannot sort out the problems of decades in weeks.
	The second key aspect is the need, at the very least, for the infamous level playing field between the NHS and the private sector. All too often, the independent treatment centres, which are supposed to be the dynamic, free-market, capitalist competition that will ensure efficiency, are being subsidised and given guaranteed business. That is the exact opposite of what should happen. For example, a doctor wrote to me recently saying:
	"One contributing factor"—
	to the problems of the NHS—
	"is the...Treatment Centre...in Shepton, which is treating straightforward patients for routine ops at an inflated tariff and leaving the more complex cases, as well as sorting out their errors, to the local NHS."
	He makes an interesting point when he states that the number of staff working there is very similar to the number of redundancies at the Royal United hospital, Bath. He says that that is no surprise, as those staff members are doing the work that the RUH has lost, although at a higher price. That cannot be a rational way to manage efficiency in the health service.
	The shadow Secretary of State, the hon. Member for South Cambridgeshire, asked about what should happen when a district general hospital "loses business", as the jargon has it. He did not answer his own question, but the logic of the Government's policy is clear, and it is that district general hospitals may close when their work can be taken up by regional specialisms, treatment centres and GP surgeries. However, have the Government talked to the British public about that? Has there been a debate about whether we think that district general hospitals have a future?
	The answer to both questions is no. We have had no such debate. What is missing most of all from the NHS is real local democratic accountability. The NHS employs 1.3 million people, or one voter in 35. The only person democratically accountable to all those people is the Secretary of State, who has just left the Chamber.
	I shall give the House an example from my own part of the world. In the former area of Avon, none of the local MPs and councillors, regardless of party, wanted the PCT configuration, but the health authority just said, "Tough." Where is the democracy and accountability in that?
	That is not merely a constitutional point. We want the NHS to be genuinely accountable and answerable to us not just because we pay for it, but because that would be more efficient. Local people and those whom they elect would be able to scrutinise what went on and ask pertinent questions. At present, they are completely shut out; only one person is accountable for the NHS, and she takes no responsibility for it.
	Over the past nine years, the amount of money going into the NHS has risen from historically low levels to something more credible, but the problem has been the endless interference and issuing of diktats from the centre. Local discretion has been limited, but the blame when things go wrong is always shifted to local NHS management.
	That has to stop. We want real local democratic accountability, and that will mean that the NHS is different in different parts of the country. That is what local people want; they should be allowed to have it, and not be told from the centre how things are going to be.
	We should not go back to the pre-1997 regime that failed the NHS. There have been real improvements since then, but we need a measured pace of reform, serious accountability and decentralisation. Running an organisation of 1.3 million from one office in Whitehall is not the way to proceed.

Howard Stoate: Yes, I believe that we should. A few years ago, when I was a member of the Select Committee on Health, we looked at that issue and recommended blurring the boundary and breaking down that Berlin wall to achieve much more integration of budgets and personnel so that people work across both sectors.
	If we removed the boundary between primary and secondary care, we could provide the care that the patients need, whatever the location, without competing pressures between social and health care, or between primary and secondary care. The system would be much smoother, and patients could understand it. It would achieve what they want and deliver efficiencies. I would go further, as we need to ask what is the role of the acute hospital in the 21st century. That dangerous question needs to be handled subtly—Members on both sides may fear that there is threat to their own unit—but we must have that debate. An acute unit capable of delivering emergency care, followed if necessary by transfer to a more appropriate unit after stabilisation, is required in each district, but what should be provided beyond that? Does the district general hospital need all its acute beds? Is that requirement appropriate in every instance? Is it appropriate for every speciality to be provided in every district general hospital? Do we need a full range of services in each unit?
	The vast majority of acute admissions are entirely avoidable, particularly for people with chronic conditions such as asthma or diabetes. Those admission should be regarded first and foremost as a sign that the system has failed. If I have to make a phone call as a GP to admit a patient to hospital, I always ask what went wrong with their care package. Sometime there is a simple answer—they have had a heart attack or stroke and need to be admitted to hospital to be stabilised and treated—but often there is a failure of social care. I have to send a patient to hospital, because there is not a safety package in the community that I can put into action fast enough to enable them to stay in their own home.
	When we send a patient to hospital, it is usually a nightmare. Elderly people, in particular, become institutionalised after only a few days, and it is much more difficult to rehabilitate them so that they can return to their own community. They become disoriented and, all too often, end up spending a long time in hospital or being transferred from hospital to a social care bed, all of which could have been avoided with more planning and blurring of boundaries. Putting people in hospital is expensive, and in many cases it is harmful to their health, particularly to their psychological well-being, as most people would far rather be treated by their family and friends in a familiar environment. Hospital-acquired infections are, by definition, acquired in hospital, not in the community. Far too many people succumb to those.
	Reviewing acute sector capacity is not just financially desirable, but essential from a clinical and a patient perspective. In the early 1960s, when the present model of the district hospital was developed, there was a need for large-scale repositories in each area, given the rather limited range of treatments that we could provide and the rather rocky patient pathway that many people followed. It was inevitable that people were kept in hospital for long terms. When I was a junior doctor, I remember working in a district hospital that had access to 1,000 beds, and we were always full. I used to admit acute surgical patients to the ear, nose and throat ward because I had nowhere else to put them. That was 20 years ago. We now have far fewer beds and do not face anything like the same pressures on the beds. Times have changed.

Nicholas Soames: I begin by saying how fascinated I was by the speech of my right hon. Friend the Member for Charnwood (Mr. Dorrell), and how right I think he is in his remarks about the nurses. I deeply regret the way the nurses treated the Secretary of State. It was a mistake on their part. It was clearly organised, and it was a foolish demonstration. I agree with the hon. Member for Dartford (Dr. Stoate) that nurses are far better paid than they were, and so they should be. That manifestation was not about pay at all. It was about the constant rate of change in the health service, which is proving so destabilising and bringing such great uncertainty not only to those who work in the health service, but in the long term to patients.
	In speaking to the motion, I commence with the words of the magnificent Jeff Randall, one of our foremost economic correspondents, who remarked in his column the other day that it takes a very special, not to say a unique, genius to triple state expenditure on the NHS in 10 years to £96 billion, while simultaneously creating a financial crisis of such severity that perfectly good hospitals are closing, wards are having to be shut down and services cut, thousands of highly trained nurses are losing their jobs and there are few jobs for newly qualified doctors.
	In the south-east of England a health care crisis is developing throughout the region, and dealing with it will be extremely difficult. The Chancellor made a colossal error by announcing massive increases in public expenditure on health without demanding substantial productivity gains and further reforms. A very great deal of taxpayers' money has been wasted and is about to be so again, and there is a substantial managerial failure which lies at the door of the Department of Health. It is not a failure, by and large, at local level.
	Let us start where credit is due. The NHS needed more money spent on it. There has been a broad improvement in a substantial range of services and the right hon. Lady is to some extent right to feel that the press, as always, concentrates too much on the reporting of people's negative experiences. All of us Members of Parliament know that serious complaints are made, but on the whole my postbag is filled not with complaints, but with letters from people saying how well they were treated and how grateful they are to the doctors and nurses for their skill and care.
	However, much too much money is being wasted in the health service. For example, after seven years of wasted planning time, St. Mary's hospital, Paddington decided not to replace its Victorian buildings with a new hospital, by which time the trust had spent £14 million on consultants' fees. That is not acceptable, and there are many such examples.
	There is a mixed picture, and in respect of my own constituency I shall say something about the Princess Royal hospital and the Brighton and Sussex University Hospitals NHS Trust. I have raised these matters on the Floor of the House on a number of occasions and at a series of meetings with Ministers, and I do not want to go over old ground. As I have said before, the trust is £21.3 million in debt, with no possibility, in my judgement, of paying it off in the time scale required. A similar point was made earlier.
	I warned the Government at the time the trust was created what would inevitably happen when the two hospitals were merged. The position now is that a turnaround team has reviewed the situation with the trust managers and it is my firm conviction that, unless the debt is dealt with in a sensible manner—we must leave headroom and time to support a full recovery process—the trust inevitably will have to make substantial cuts in services, close wards and reduce vital services for local people. That cannot be what the Government want and it is certainly not what my constituents want. It would be a disaster locally and would, I am afraid, further damage my constituents' confidence; already bruised following the "best care, best place" consultation.
	I appeal to the Minister to accept that the trust is struggling with long-term financial burdens; they are not its fault and are, frankly, beyond resolution. The Government should not reward poor financial stewardship, but where such a situation exists—as it does with this trust and many others in the country—alongside a genuine commitment from the management and capacity to reform and increase transparency, the Secretary of State should act in a sympathetic and understanding manner.
	I want to speak briefly about the future of the NHS. The national health service employs 1.3 million people. In Surrey and Sussex alone—my part of the world—the budget is £2.8 billion and the NHS employs more than 50,000 people. On any one day, 4,500 people will be occupying a hospital bed and 1,100 will be admitted to hospital, of whom 720 will return home that day. About 2,350 people will attend an accident and emergency department on any one day in Surrey and Sussex, of whom about 560 will be admitted.
	The local Surrey and Sussex health economy is now in great difficulty, from which it will be difficult to extricate itself. It is not possible any longer to run an organisation of this size as it is, and I believe that change is required, particularly around the issue of accountability at all levels. I applaud the work that the Government are carrying out to try to get that done, but I firmly believe that we need significant devolution of responsibility, autonomy and accountability at the local level and that it will be possible and equitable only if managers and clinicians are able together to set local strategies, targets and service delivery. They should be agreed by the strategic health authority, monitored according to that agreement and set within the SHA's financial framework, aligned to the strategy of the Government of the day.
	The NHS will never work efficiently and truly effectively until empowerment and ownership of services and service delivery are an absolutely integral part of the success of achievement. At present, many of the clinicians to whom I speak are, as my right hon. Friend the Member for Charnwood argued so effectively, feeling disillusioned and disconnected from the process and restrained. Managers who, given their heads, could do a much better job, feel disempowered and are unable to take initiatives that they know to be right. Only in genuine partnership will clinicians and managers be able to deliver the sort of dynamic service that is really responsive to the needs of patients. We need that to happen now and the Secretary of State needs to do more to encourage it and to make it happen.
	It has always been my experience in public life that pay is not the only driver for those who work in the NHS or elsewhere in the public services. Job satisfaction, improving patient outcomes, applying new and valuable initiatives and good systems changes, alongside feeling valued and respected, are just as important. Ethos matters very much to most public servants. There are some outstanding managers in the NHS, but there are also too many inadequate ones who are recycled from job to job. The good ones need to be nurtured and developed. Initiative, and particularly risk taking, needs to be encouraged and managed.
	I have a suggestion for the Minister, which he is at liberty to use. I believe that the Government should set up a staff college, based on the services model, to which all managers marked out for further and higher command above a certain level in the NHS have to attend. Such a course could be run at business schools throughout the country to ensure that only the very best managers go on to the most important jobs. As in any other business, the leadership or senior management is absolutely crucial to the success of the enterprise. The NHS should be no different, so my right hon. and hon. Friends are right to be critical of the Secretary of State in that respect.
	In the last five years, the NHS budget has increased by 40 per cent. in real terms, while output has increased by less than half that. In its doctors and nurses, the NHS has one of the most committed work forces in the country, yet management has significantly failed to motivate and engage those dedicated professionals towards a common goal of increased productivity.

Siobhain McDonagh: No.
	Most importantly of all, we have recently received the Secretary of State for Health's support for a new critical care hospital that will be the envy of everyone in our area. If hon. Members want to see an example of how this Government are tackling inequalities, they could do no better than to take a trip to look at health services in Mitcham and Morden. My constituency is probably the most disadvantaged in the whole of Surrey or outer south London. The Tories' approach to that inequality was to take away our health services, force us to cope with grotty GP surgeries and shut our hospitals. Labour's attitude involves doubling investment, building brand new GP surgeries and health centres, and reopening and rebuilding our hospitals.
	Sadly, however, there are still some who share the ethos of the Tories, who believe that health care should go where the people shout loudest, rather than where the greatest need is. I do not wish to criticise dedicated and hard-working NHS doctors, nurses, ancillary staff and managers who share our commitment. However, there are still a few people in place who take a bureaucratic approach to health care, rather than a human approach.

Siobhain McDonagh: I will not give way.
	As I have said, my constituency is one of the most disadvantaged in our strategic health authority's catchment area, with some of the greatest health needs, yet when the axe had to fall throughout the '80s and early '90s it was my constituency that suffered most. In the past few months, we have uncovered secret plans by the local health authority dating back to the mid-1990s. It proposed to shut St. Helier, but thankfully was unable to do so before Labour came to power.
	St. Helier hospital is not in my constituency—it is in a Liberal Democrat constituency—but it serves half of my constituents. The health establishment has for many years scorned Mitcham and Morden. Even now, despite many complaints from me, no one who lives in my constituency is on any NHS board, either of a primary care trust or a hospital trust. So I should not have been surprised when St. Helier came under threat again more recently, when the administrators decided that they wanted to remove critical services from the hospital. It was saved only following the intervention of my right hon. Friend the Secretary of State for Health.
	Those administrators argued that the site of the main hospital—the critical care hospital—was not important, as the community hospitals would take most of the people who normally go to hospitals. A public consultation was conducted, and it soon became clear that the main issue would be where to put the new critical care hospital, which would house the area's accident and emergency unit, and acute services such as maternity and obstetrics.
	My view is that the people who need critical care services the most are those who are most disadvantaged and have the worst health. There is a strong link between social disadvantage and the need for emergency services and health needs such as low birth weight and teenage pregnancy. The bulk of the population live near St. Helier, and the vast majority of those with the greatest health needs live there. They are those with the lowest life expectancy, those who experience the most emergency admissions, the highest levels of child accidents, the lowest levels of good health and the most long-term illnesses. The also include those with the most babies with low birth weight, the least access to primary care, the lowest incomes and the least access to cars. The area also has the largest black and ethnic minority population. For all those reasons, I felt that having the critical care hospital at St. Helier was the best way to reduce health inequalities. The public consultation seemed to agree— [ Interruption.]

Richard Taylor: I take that point.
	The debate is about management of the NHS, so I shall refer first to reforms. In 2002-03, the Health Committee's report inquiring into foundation trusts started with a table quoted from the  Journal of the Royal Society of Medicine, which listed the reforms that had taken place between 1982 and 2003 under Governments of different colours. There were 12 reorganisations between 1982 and 1997, another six between 1997 and 2003, and since then, as panic has set in, there have been at least 10 more—practice-based commissioning, payment by results, "Agenda for Change", new contracts, reorganisation of trusts, independent sector treatment centres, out-of-hours care, the computer program, the primary care White Paper and the abolition of the Commission for Patient and Public Involvement in Health. The NHS is supposed to be patient-led, but none of those have come up from the bottom; they are all top-down.
	For example, by and large, independent sector treatment centres are against local wishes. I have just received a letter from one of my ex-housemen, who is now a professor of magnetic resonance imaging. In respect of independent sector scanners, he wrote:
	"I am not aware of any attempt at all to evaluate whether or not the NHS could have provided this extra capacity. Many NHS MR systems are under-utilised owing to either revenue or staff shortages."
	He also wrote:
	"There was no consultation locally on Wave 1—it was presented as a 'fait accompli'"
	In relation to primary care trust mergers, everyone in my area is against the loss of their own PCT for their own part of the county. That has been made clear at all levels, and any movement on the matter is most unlikely. I have heard other Members make similar comments this afternoon. PCT mergers are not in accordance with local wishes; they are top-down.
	The abolition of the Commission for Patient and Public Involvement in Health will have a devastating effect on local forums, removing the very bodies that could communicate the patients' and public's needs and wishes. Abolishing the CPPIH two years after its institution does not strike me as good management. Equally, abolishing PCTs just two to three years after inception, just as they are beginning to work, does not seem to me to be good management.
	The Government-inspired reforms, especially their number and top-down nature, lead to problems. The person who wrote the article listing the number of reforms from 1982 to 2003, quoted in the Health Committee report that I mentioned, wrote subsequently that
	"perpetual reform is very costly, both in terms of the time and effort invested by managers and other NHS staff, and in terms of the financial costs of establishing the physical fabric of new organisations and of meeting the redundancy or retirement costs of displaced staff. It can create a significant diversion of time and effort from the focus on delivering improvements to patient care, and, crucially, may promote a cynical attitude to innovation and change in the NHS".
	The Health Committee report on the merger of primary care trusts followed up that theme. In our summary, we wrote;
	"It is clear that the impact of proposed reconfigurations on PCTs' day to day functions, including clinical services, will be substantial—it takes on average eighteen months for organisations to 'recover' after restructuring and to bring their performance back to its previous level."
	We continued:
	"After the immediate disruption of reorganisation, it is thought to take a further 18 months for the benefits to emerge—a total of three years from the initial reforms. Thus, just as the benefits of PCTs (established in 2002) are about to be realised, the Government has decided to restructure them."
	The Government attempt to justify the NHS deficits on the basis that they only affect a minority of trusts. In relation to the 2005-06 deficits, that seems to be the case. What we desperately need to know—I am pleased that the Health Committee will undertake an inquiry about this in future, as we might then find out the real scale of the deficit—is what savings all trusts across the country must make to be in balance by the end of 2006-07. That will give us some idea of the true deficit.
	I have thoroughly welcomed the extra money that has gone into the NHS, but the Health Committee has heard some worrying facts about what happened to the extra £6.6 billion this year. Nearly half has gone on pay rises and other expected things, but much of the other half has gone on uncosted or inaccurately costed contracts, PFI costs, independent sector costs, the computer system and the pharmacy contract. At that stage, there has been mismanagement of the vast amount of extra money that has gone in.
	With regard to the private finance initiative, would people now allow a PFI contract to be written with a clause stating that if bed occupancy goes above 90 per cent, there would be extra payment? Before the changes removing the need for some hospital beds, not all of which have taken place, as the hon. Member for Dartford (Dr. Stoate) mentioned, initial PFIs were made with fewer beds. Allowing a contract to have a penalty clause for occupancy levels that would inevitably be reached was inexcusable. During one meeting of the Health Committee, we tried to find out from top civil servants how widespread the practice was. The civil servants promised to send a note because they could not answer at the time, but I think we are still waiting for that note.
	There is another sad aspect of the private finance initiative. Forecasts were made of its unaffordability, and my own trust has now admitted that approximately £7 million of its deficit of nearly £30 million is owing to the PFI.
	We should also ask what managers in any concern other than the health service would allow independent-sector treatment centres a fixed contract for a guaranteed number of cases, to be paid for within a fixed time regardless of whether they have been dealt with, while at the same time NHS treatment centres struggle to make ends meet? That strikes me as a little odd, and it strikes me as poor management.
	Another thing that worries me, and worries many people in the NHS is who would go fast and furious down the road to privatisation when there is so much opposition from health workers of all kinds? The fact of resistance is proved by the appearance of the group called "Keep Our NHS Public", which has been joined by a good many junior doctors.
	Some expenses resulting from Government rulings on top-down management seem to me fairly ridiculous. They may be controversial and I may be wrong, but I want to mention them. Clinical risk managers, for instance, are senior nurses who have been taken away from their jobs looking after patients in order to manage risk. Has there been any study of their value for money? The same question could be asked about quality managers. As for the plethora of "modern matrons", that is really just another name for the departmental nursing officers whom we have had for years and years.
	The typical image of a matron is that of the archetypal figure in a smart uniform who sails around a hospital and puts the fear of death into all the nurses and doctors. That one person can do more in terms of risk, quality and the standard of care than any number of highly paid modern matrons. If I were looking for savings, rather than getting rid of practising, working nurses on the wards I would get rid of risk managers and quality managers. I would return the modern matrons to their jobs as nursing officers and bring back "the matron" who is not bothered by management or the reforms that she must introduce, but is purely and simply concerned with quality.

Kali Mountford: No, I am finishing my response to the point made by the hon. Member for Romsey (Sandra Gidley), which deserves an answer. We are entitled to expect results from consultants, but should such an expectation be included in their contract? There is a proper argument to be had about what should be included in the contract, and in my view, we should be able to demand certain outcomes from consultants. On the other hand, there are those who criticise the Government for insisting on certain outcomes.  [Interruption.] The hon. Member for Romsey shakes her head. Perhaps she is not among those critics, but Conservative Members certainly have made such criticisms. They say that the medical profession should decide for itself how it operates its businesses.  [Interruption.] The hon. Member for Beverley and Holderness decries my argument, but I have heard his own Front Benchers say, "Leave it to the medical profession. Free it up to do whatever it likes." That is a nonsensical approach. However, the hon. Member for Romsey made a valid point and it is worthy of consideration.
	It is very important that we motivate NHS staff and show that we value the work that they do. It is disappointing that they have other issues with us, and the House will be surprised to hear that I do not entirely blame them. Their concerns are entirely understandable. As someone who had to manage change in large organisations, I entirely understand how difficult it is for people to cope with continual change, which leaves them feeling in a state of flux. We need to do more to manage change.
	I am not entirely convinced by the argument of the hon. Member for Northavon (Steve Webb), who said that the problem is that change is happening too fast. Some of my constituents would cry out for more and faster change if they felt that it would benefit patients. The question should be: what will bring about the best results for patients, not for doctors or managers? These are very difficult problems to grapple with. A continually changing NHS is having to cope with new treatments coming on stream, for example. We need to balance the NHS's differing demands in a sensible way. Simply slowing down the process of change would not, of itself, be the answer.
	That brings me to a very difficult problem. A lot of change is taking place in my own area. The hon. Member for Shipley (Philip Davies), who slid out of the Chamber earlier, drew the House's attention to an independent candidate who stood on a ticket of opposition to change in the NHS. Incidentally, that candidate beat a Liberal Democrat in the local elections—a point that the hon. Gentleman failed to mention. I can understand why some people say, "We don't want change in the NHS." They have grown to value the NHS and they feel that it is best left as it is—until they hear of a new treatment, which they want "today". Herceptin is a valuable example. At first, the primary care trust in my constituency refused to supply it, but after some debate about the savings to which its introduction could lead, the PCT changed its mind, and patients now have that choice.
	That brings me to the question of where the balance should be struck. We have said that decisions should be made as locally as possible, yet when they are so taken—free from political interference, hopefully—do PCTs, which are charged with responsibility of consulting the public on such changes, listen sufficiently carefully? How should they then balance public demand against what clinicians tell them is best for patients? Conservative Members have put forward both sides of the argument. They have said, "Save my hospital, because I don't want anything to change", and in the very next breath said, "We ought to allow such issues to be decided locally, and we should be brave enough to shut down certain hospitals."
	The truth is that both positions can be right. Some hospitals have simply outlived their usefulness. St. Luke's hospital, in my constituency, mainly cares for patients with mental health problems. Mental health treatment has changed enormously in recent years, and it right to reconsider how we provide such care. St. Luke's has acquired a new building that is closer to the general hospital, and it could be used in a different way. The administrative facilities could be moved into that building, thereby allowing new treatments to be delivered properly in a major hospital.
	For some people, a major hospital is not a pleasant experience or a good place to be. It is better for those with mental health care needs, in particular, to be treated in their own homes by a community nurse or a community psychiatric nurse. Such decisions are the appropriate ones to take, but there are more difficult and demanding ones. Sometimes, the clinical need is not clear, and the community take a different view on what should be delivered from that taken by the PCT, the hospital trust or even the Member of Parliament.  [Interruption.] I see that the hon. Member for Shipley has returned to his place, and I am very glad that he is here. When he stood against me in 2001, I enjoyed his company greatly. I also enjoyed it when he stood for election to the local council, and I am sorry to have to tell him that his friend, who stood and won, has now lost her seat. I am grateful to him for bringing to the House's attention the fate of his own party and of the Liberal Democrats.
	The independent candidate to whom I referred earlier won her seat fighting on a ticket of opposition to NHS cuts. It is easy to utter slogans about health, but it is not a responsible thing to do.  [Interruption.] Conservative Members laugh, which may sound fine in a debate, but it is not a very sensible attitude to take. If we are to make proper decisions about local health care, we have to accept that those decisions will sometimes be difficult and that sometimes the public need to be listened to. Part of the argument about hospital reconfiguration in my constituency—which needed more care in the decision making—concerned maternity services. The hon. Member for Romsey and I have discussed the issue in the Chamber before. The way in which maternity services can be delivered is changing and that should be part of a plan, but it should not be the only plan.
	The difference between maternity services and, for example, mental health care, orthopaedic care, heart surgery or cancer treatment is that all those expecting a baby hope and expect that their experience will be normal and a family event. They do not necessarily consider it as a health intervention. In fact, it would be a bad thing if they did. Birth should be as ordinary and as happy an experience as possible.

Kali Mountford: In fact, my community disagrees with the PCT. The community want an ordinary maternity unit in the local hospital and does not want a midwife-led unit, so we are on opposite sides of the argument. My personal view is that midwife-led units can, in the right circumstances and with the right support, be of great benefit. Midwives are the right people to make decisions and help a mother through all prenatal care, the delivery of the baby and some of the postnatal care. The relationship that can be built up over a period of time is valuable to a safe birth and important in helping mothers to take decisions that lead them away from unnecessary interventions, such as elective caesareans. As soon as a pregnant woman visits the local maternity unit, she sees shiny pieces of equipment and thinks, "Oh my God, I need some of that. It is bound to all go wrong and I want to ensure that I am as near to that equipment as possible." That has been the undercurrent of the debate on health.
	Some people in the community claim that the issue is cuts in public spending on health, but nothing could be further from the truth. In fact, the argument started five years ago when the health authority took a decision against the advice of the hospital, which wanted to move maternity services into one huge unit—a sort of super maternity unit. We rejected those plans, although the hospital claimed at the time that it was a matter of clinical need. The hon. Member for Wyre Forest has mentioned clinical need, but the problem is that clinical decisions are not always straightforward. Clinicians argue about them all the time. Indeed, clinicians from all over the country came to my constituency to argue about the best way forward for delivering babies. There is not only one point of view or one way of delivering excellence. That is fine, if the community backs the eventual decision. If everybody in my community demanded a midwife-led unit, I would not blame them for doing so, because it could be an excellent move. However, if it were introduced against the wishes of the community, we would have a problem, because it would be set up to fail —[ Interruption. ] The hon. Member for Westbury (Dr. Murrison) laughs, but—

Kali Mountford: I accept that, and my constituents want the choice. However, they do not want the option that is being presented to them, after a lengthy consultation, by the PCT. The PCT received a petition with 50,000 signatures and 2,000 postcards from my constituents—the proposal covers three constituencies—and a different petition with 30,000 names. Despite that, it came to its bizarre conclusion because the clinicians thought that the best way forward was to separate out maternity services, send potentially difficult cases to another hospital in a different town and have only a midwife-led unit in Huddersfield. The community said, properly, that it was used to what it already had and did not buy into the PCT's suggestion. The hon. Member for North Wiltshire said that his constituents value their midwife-led unit, but my constituents do not yet agree with him. They demand the choice, and perhaps that is where we agree.

Kali Mountford: The hon. Gentleman needs to think again about how he presents his argument —[ Laughter. ] Well, Opposition Members laugh, but they are misrepresenting the case. It is the primary care trusts who are charged with the task of consulting the hospital trusts and making the decisions. It was a clear decision by the Government that such decisions should be made locally, and that is where the next dichotomy arises. The community in my area want one thing, but the PCT and the hospital trust have come to a different conclusion. I want decisions to be taken locally that take account of the community's views. Where do we go from there? Well, we go to the Secretary of State, who then acts as an arbiter.
	My personal view is that we should have an independent inquiry into the issue. PCTs must take their responsibility for their communities seriously. They are charged with the duty of consulting properly. In this case, no fewer than 100,000 people—assuming that people signed only one of the petitions—made their views known, and if the PCT does not take account of that, it should look closely at the way in which it makes decisions —[ Interruption. ] Opposition Members are giggling and perhaps they will share the joke with the House when they make their own contributions. Why do Opposition Members think that it is funny that I want to champion the cause of my community, which has had a dreadful experience with a consultation with the PCT?
	I have had several meetings, and a debate in Westminster Hall, about this matter. I am unhappy that my constituents will not get the service that they are demanding, but also at issue are important questions about how we set up the local delivery of health services. How do we charge PCTs with the task of making sure that those services are what is wanted by the people who, through their taxes, pay their wages? That should be a simple question for Opposition Members to understand, but ensuring that we have a democratic NHS might be too difficult for them.
	The hon. Member for Wyre Forest (Dr. Taylor) said that clinicians were the only people who should take such decisions, and that the balance must lie somewhere between the outrage exhibited by Opposition Members on the one hand and that expressed by Labour Members on the other. He may be right about that, but arguments about the local delivery of the NHS should not cause us to blame the Government for local decisions, nor to do the opposite—that is, scurry back to the Government about every local decision that we do not like.
	The argument is difficult, but there is one matter about which I agree with Opposition Members, so perhaps they should not giggle quite so much. The hospital trust in my area is being reconfigured, but changes in the PCT are also being considered, as I shall explain.
	The PCTs have more money to spend in our communities than ever before, and they control huge budgets for the delivery of community services to our constituents. That is valid and valuable but, when PCTs were being set up, I argued fiercely that they should be as local as possible. I was very glad that it was decided that my PCT should be very small, as my community is very different from the ones that surround it. I thought it important that my constituents' views about how their money is spent on their health services should be taken properly into account, and I still do.
	My right hon. Friend the Member for Rother Valley (Mr. Barron) spoke about health inequalities. The inequalities that exist between my constituency and that of my hon. Friend the Member for Huddersfield (Mr. Sheerman) are very stark. Given that PCTs are being reviewed, it is important that the proposed new structures are looked at.
	I have made a counter-proposal and I hope that the Government will listen to it. It should be clear to the House that I place great value on giving people in the community a say in how the NHS is run. I understand why a bigger PCT could deliver better value for money, and why bigger management teams could be slimmed down. However, I fear that that approach could cause us to lose something that I value very much—community involvement in the NHS. The House may not value that as much as I do, but I believe that that is how we can make sure that what is delivered is in the best interests of my community.
	My proposal is that we look at how we can build a smaller, locality-based form of PCT into the overarching management committee that covers a number of PCTs. I have discussed the idea at length with my right hon. Friend the Secretary of State and other Ministers. The advantage would be that funding for each area could be ring fenced and so deal in part with the problem raised by my right hon. Friend the Member for Rother Valley. That is, people in richer areas would not be able to raid the funds of the poorer areas.
	There is a huge difference in how the two PCTs in my area are funded. The per capita funding has been greatly reduced for people living in areas where health inequalities have had less impact, whereas it has been greatly improved for the poorest people. That has to be right, but my fear is that a much larger PCT would have an adverse effect on the management of health inequalities.
	Such problems matter. If we do not think about patients' experience of the NHS, value what they say about what they want and stop the richest raiding the funds of the poorest, how can those who need the most get what they need? I hope that Ministers and the Secretary of State will look carefully at the proposals for the Kirklees PCT, and the proposals that I have made about making the best use of resources. I accept that an over-arching executive board would be cheaper than having three separate boards, but we must retain the important and valuable role played by non-executive board members. Their work as advocates for their local communities will mean that, when future consultations are held about the provision of health services in my area, people can be assured that they will get value for money and the health service that they crave.

Anne Milton: My problem is that I was not a Member of Parliament then. I remember what it felt like in the NHS and perhaps it is of note that it was because of my experience in the NHS that I went into politics—and I am on the Conservative, not the Labour Benches. There is a reason I joined the Conservative party and not the Labour party and if Labour Members really want me to go back and describe the situation in the NHS when I was a nurse, I will gladly tell them about it. When I could not get a porter to take a patient to the ward and wheeled him myself, the porters went on strike for 24 hours because I was doing their job. We can all go back, but, as I said earlier, it is important that we look ahead.
	The situation for my constituents in Guildford feels rather grim. We have a review of acute services in Surrey and while we would welcome many of the changes that the Government are talking about and that the hon. Member for Dartford mentioned, maternity services, paediatrics, and accident and emergency at the Royal Surrey county hospital are all going to be under threat. The problem is that, on the one hand, the Government talk about delivering services more locally and closer to people's homes and, on the other hand, they talk about reviewing acute services and moving such things further from people.
	I admit to a certain amount of confusion and we have heard a confused story this afternoon and this evening. A lot of Conservative Members have talked about community hospitals and midwife-led units closing, while some Labour Members have told us how wonderful the NHS is. My constituents have been refused PET scans and DAT scans, and even a hernia operation, because the PCT is not buying them any more, on the grounds of cost. The hospital says that the PCT will not pay for them and the PCT says that it has funded them, but the patients are left terribly confused and do not know who is making the decision. The NHS about which some Labour Members talk is not the NHS that I recognise at the moment in Guildford. The situation is not all bad, but there are serious problems and we are finding that our services are being cut.
	The headlines that we have seen in the papers recently are not just made up. Such headlines include "10,000 nurses 'can't find a job' in cash-strapped NHS" and "Treatment centre programme in disarray as contacts axed". The hon. Member for Wyre Forest (Dr. Taylor) talked about that problem earlier. The new independent sector treatment centres are being paid whether they do work or not. They are coining in the money, but are operating at about 50 per cent. They get the money even if they do not do the work. Other headlines include "How NHS cash goes to waste on private ops", "NHS 'facing worst financial crisis'", "Threat to funds for medical training as hospital advertises for four risk assessment managers" and "NHS faces job cuts as financial crisis deepens". Those stories are not made up.
	I urge hon. Members on both sides of the House not to dismiss contributions from Conservative Members as political posturing. I also urge Conservative Members to consider what they have heard from Labour Members. We have to find a solution. I know that I need to protect and look after my constituents and that they need and deserve a better NHS than they are getting at the moment. It would be becoming of all of us to look ahead and find real solutions to some of the problems.

Diana Johnson: I disagree with the hon. Members for Guildford (Anne Milton) and for Northampton, South (Mr. Binley). I passionately believe that the NHS and health care is a political matter. Hon. Members who choose to vote against increases in funding to the NHS and health care are making a clear political statement by doing so, and that is to be regretted.
	In the city that I represent in East Yorkshire, Hull, we have people who are severely disadvantaged in terms of the economic success that they enjoy, the jobs that they are able to get and the health care that they were able to access in the past. Examining and investing in public health in Hull is key to the future prosperity and regeneration of Hull and that part of East Yorkshire. The life expectancy of a man in Hull is at least two and half years off the national average. For a woman, the corresponding figure is just over a year. That says something about the health of people in Hull. We need to discover where health inequalities exist and address them.
	In Hull we have single-handed GP practices, with GPs operating in small houses that they have changed into surgeries. Those are not suitable for the kind of health care that we need in 2005-06. In the past, the emphasis was on acute hospitals—district general hospitals. We will always need hospitals, but we also need to ensure that we invest in our community sector. I was pleased that there was some debate earlier about the LIFT programme and the money that the Government have identified to go into enhanced service delivery for GPs, linked to the wider regeneration of areas such as Hull.
	I would like to deal with the effect on my constituency of the massive investment that has been put into it over the last few years, particularly in respect of the Hull and East Yorkshire NHS hospitals trust, an acute trust. About £6 million has been invested in the creation of the Hull and East Yorkshire eye hospital and £35 million has been put into the building of the Hull and East Yorkshire women and children's hospital, which opened two years ago. Plans are afoot—the first contractors are on site—to build a £45 million cardiac and elective surgical facility at the Castle Hill hospital site, and £60 million is available for a new oncology centre at Castle Hill. Several other smaller capital developments are either planned or already in progress. My constituents are really seeing the benefits of massive investment in the NHS in Hull and east Yorkshire.
	My area in Hull is rated ninth out of the 354 local authorities and districts in the country in respect of disadvantage and deprivation: health care is thus a key issue for us. I was very pleased that the Hull York medical school came to the Hull university site a few years ago, which meant that we were training doctors who would, we hoped, decide to make their careers in the Hull and East Riding area. We put in a bid for a new dental school, but it was unfortunately not successful. I remain hopeful of another round and another strong bid from the Hull York site, which should be viewed favourably by the Government.
	I want to finish with a few comments on some recent visits that I have made. The first was to the East Yorkshire eye hospital. I encountered a fabulous NHS staff team there, including a consultant who told me that, from the day he sees someone who needs a cataract operation, he can be operating nine days later. I believe that that is phenomenal when we think that a few years ago, people in Hull and elsewhere had to face months of misery before having a cataract operation. Nine days is brilliant and something to be very proud of.
	We should also pay tribute to the flexible way in which NHS staff now work. It was interesting to hear from the hon. Member for Wyre Forest (Dr. Taylor) about what I thought was a rather old-fashioned way of demarcating doctors, nurses, matrons and so forth. What I felt was so refreshing when I visited the eye hospital was the fact that the consultant, the nurses and the administrators worked incredibly well together to ensure that the patient experience was the best possible. It was a real team, which recognised the importance of working as a team. There was no pulling rank in the sense that the consultant had considerable experience while others did not: they operated as a team, which demonstrates the way forward.
	I would like to say a few words about the Hull and East Yorkshire women and children's hospital, which provides midwifery-led care. We also have the Jubilee birth centre, which is totally midwife led, but the costs are quite high. We have to think about costs and the type of facilities that we provide to expectant parents.

Stephen Hammond: I want to make two brief points. First, I welcome the two new Ministers—the hon. Member for Leigh (Andy Burnham) and the hon. Member for Bury, South (Mr. Lewis)—to their posts and wish them success. I have sat through the long debate, in which we had, with one notable exception, thought-provoking, valid contributions of quality.
	My first point is a macro point. No hon. Member wants the NHS to be out of financial balance. However, the Government's macro reality is that they are spending £96 billion on the NHS, whereas my micro reality is that my local acute hospital and my PCT are in deficit. The Government's macro reality is that, as the Secretary of State said, the financial problems are always created by the trusts. That is not so. The bulk of my constituents in Wimbledon look to St. George's as their acute hospital, which is in the constituency of the hon. Member for Tooting (Mr. Khan). I have spoken to the financial director, Mr. Colin Gentile, and the turnaround team has done a good job. However, one of the problems that exacerbated the deficit was the inability of the Department of Health to get its tariffs correct in the first place. Although the Government say that the problems are always caused by the trusts, that is not the case.
	Secondly, let me consider the local point. The hon. Member for Mitcham and Morden (Siobhain McDonagh), who is no longer in her place, made an ill-tempered contribution, in which she allowed no interventions. Her constituency is next to mine and we share a borough council and a health reality. The health reality that she portrayed was not that that some of us experience. Yes, several improvements have taken place at Sutton and Merton PCT but she should also have said that it has deficits. Some are due to overspending, which it needs to put right, but others, as in the case of St. George's healthcare trust, are due to a problem about which it could do nothing. An arbitration settlement from three years ago hit it. Community practice nurses, the district nursing service and the home health visiting service are consequently being cut. The White Paper states that community health provision should not be cut as a result of short-term budgetary issues. I ask Ministers to think about that.
	The hon. Member for Mitcham and Morden also spoke a lot about the "Better Healthcare Closer to Home" project, and about her supposedly great victory in retaining St. Helier hospital. St. Helier was never going to be closed: it was either going to be a local care centre or an acute care trust. She misrepresented the situation several times, and I look forward to reading  Hansard carefully tomorrow and, I hope, making some points of order and asking for some corrections.
	The overwhelming point is that, although the Secretary of State granted the hospital a reprieve as an acute care trust, she failed to consider what would happen to the local care trusts. As a result of that decision, the whole "Better Healthcare Closer to Home" project has now gone into abeyance, and the business case has been distorted. My constituents in Wimbledon, who want to see excellent local primary care delivered through the local care hospital, can no longer be certain that that will happen, either in the given time scale or at all. I am seeking reassurance from the Ministers that it will happen.

Andy Burnham: I thank the hon. Member for Eddisbury (Mr. O'Brien) and others for their kind words of welcome. Love identity cards as I do, it is nice to be back on home ground. I do not know whether the hon. Member for Wellingborough (Mr. Bone) had me in mind when he said that he thought that the Government were more interested in spin doctors than real doctors, but I can assure him that I did a real job once in my life, for the NHS Confederation, and I have served on the Health Committee, so I am not entirely new to health policy.
	I pay tribute to my predecessor, my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy). She can point to real improvements during her time in office that will be of direct benefit to patients, including the speeding up of the NICE appraisal process and, more recently, the conclusion of deals for the rebuilding of Barts and new hospitals in Birmingham and—closer to home for both of us—St. Helens. I hope to build on her work.
	We have had a debate of two halves. We have heard serious contributions, raising legitimate points, from Labour Members, and some thoughtful contributions from Opposition Members, including the hon. Member for Mid-Sussex (Mr. Soames) and the hon. Member for Wyre Forest (Dr. Taylor). I listened carefully to every contribution and as a Minister new to the Department I was encouraged by the picture of progress on the ground that my colleagues mentioned. It was nice, too, that some balance was injected into the debate after the frenzy and overstatement from others. I am under no illusions about the difficult reality in some localities, but balance is important. The NHS is improving, and we have heard about that today.
	On the other side of the debate today we have seen the unedifying spectacle of some Opposition Members being determined to talk down the NHS. Today's debate was all about destabilising the NHS and seeking to create crisis—a word used by several Opposition Members today. Their plan to do so will fail, because it is not backed up by the facts. We had overstatement and bluster from the hon. Member for Eddisbury and the hon. Member for South Cambridgeshire (Mr. Lansley). However, I got the impression that the latter's heart was not in it. I have a great deal of respect for him and he has a detailed grip of health policy, but his troops were not with him. Nor were they with the hon. Member for Eddisbury just now. That is because the facts do not bear out what they were saying.
	At one point, the hon. Member for South Cambridgeshire feigned outrage. He said that patients were waiting nearly six months for an operation. That is a long time and we are determined to reduce it. Despite the problems in some areas, we will bring it down to a maximum of 18 weeks. However, I remind the hon. Gentleman that in March 1997 283,866 people had waited more than six months for an operation. Only 74 people were in that position in January this year, yet Opposition Members still claim that we have made no progress and still they talk of crisis.
	I was pleased to hear the balanced contribution from the hon. Member for Northavon (Steve Webb). He mentioned the real improvements we have seen and he rightly reminded the House of the appalling record of the Conservatives in government. He was right, too, to draw attention to the collective amnesia that they have about policies such as the patient's passport. Only seconds ago, the hon. Member for Eddisbury said that there was no difference between us at the general election and that the Conservatives were committed to the same level of spending. He forgot to say that they were committed to a policy that would have taken millions of pounds out of the national health service. That has been airbrushed from history by the Conservatives and their leader. They have forgotten about it. We will not forget about it. We know the damage that they have done.
	The hon. Member for Northavon gave us a familiar Liberal Democrat refrain and railed against central targets but, if they were the problem, the same pressures would be replicated across the country. We have heard today that the vast majority of NHS organisations are doing well and improving their services, so it too simplistic for the Liberal Democrats to blame everything on central targets. They have brought about real improvements for patients across the country, and it is right that we should continue with them.
	I was very pleased to hear the authoritative and knowledgeable contribution from my right hon. Friend the Member for Rother Valley (Mr. Barron), the Chairman of the Health Committee. He injected a note of reason and perspective into this fevered debate, and those who care about the NHS should listen to what he had to say. He painted a picture of improvement across the board in the NHS, and he was right to do so.
	As a Minister new to his post, I welcome the inquiry into NHS deficits to which my right hon. Friend the Member for Rother Valley referred. It will be a useful exercise, and I look forward to working with the Select Committee on it. My right hon. Friend is a Yorkshireman and so made some characteristically robust comments about the RCN and its recent conference. I am only two days into my job, so I hope that I will be forgiven for not commenting directly on those remarks, but I am sure that people outside the House will have heard exactly what he said.
	I was pleased that the right hon. Member for Charnwood (Mr. Dorrell) contributed to the debate, and am glad that he is back in his place. He reminded us, helpfully, of what the NHS was like in 1996, when he was in control. I was a mere Labour health researcher then, and I remember the right hon. Gentleman well. I felt that he was battling like mad to get more money into the NHS, and that he believed in it when all those around him did not.
	However, the right hon. Member for Charnwood was not able to get more money into the NHS. I remember children in the north-west being turned away from paediatric intensive care beds, and the long trolley waits in accident and emergency departments. I also remember the winter hell that recurred—to use the right hon. Gentleman's own phrase—year on year on year.

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